Gynecomastia Surgery - (0195)

Cigna covers mastectomy (CPT 19300) or reduction mammoplasty for gynecomastia only for Klinefelter syndrome or for pubertal gynecomastia persisting ≥2 years or post‑pubertal gynecomastia persisting ≥1 year when ALL criteria are met (glandular tissue on exam and/or mammogram, ASPS Grade II–IV with preoperative frontal/lateral photos, persistent pain despite analgesics, discontinuation of causative drugs ≥1 year when appropriate, and hormonal causes excluded and treated ≥12 months if present). Liposuction (CPT 15877) as sole treatment is not medically necessary and is not separately reimbursed when performed with mastectomy/reduction; coverage may vary by plan and requires the specified documentation.

"Mastectomy or reduction mammoplasty for the surgical treatment of gynecomastia is considered medically necessary for EITHER of the following conditions:"

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